Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Childhood Autism-related Outcomes
Jennifer L Ames1, Mohamad Burjak2, Lyndsay A Avalos1
1From the Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Insights
Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) was studied for links to autism. Maternal blood perfluorononanoic acid (PFNA) showed a potential association with increased autism-related traits in children.
Area of Science:
- Environmental Health
- Neurodevelopmental Disorders
- Toxicology
Background:
- Epidemiologic evidence on prenatal per- and polyfluoroalkyl substances (PFAS) exposure and neurodevelopment is inconclusive.
- Few large studies have investigated PFAS and autism-related outcomes.
- This study addresses the gap by examining PFAS blood concentrations during pregnancy and child autism-related traits.
Purpose of the Study:
- To investigate the association between maternal blood concentrations of per- and polyfluoroalkyl substances (PFAS) during pregnancy and autism-related outcomes in children.
- To assess individual PFAS analytes and their combined mixture effects.
- To explore potential sex-based differences in these associations.
Main Methods:
- Included 1,429 participants from 10 National Institutes of Health (NIH)-funded Environmental influences on Child Health Outcomes (ECHO) program cohorts.
- Measured 14 PFAS analytes in maternal blood; eight met detection criteria.
- Assessed quantitative autism-related traits using the Social Responsiveness Scale (SRS) and analyzed associations using multivariable linear and Bayesian mixture models.
Main Results:
- Most PFAS analytes were not significantly associated with child autism-related traits (SRS T-scores).
- Perfluorononanoic acid (PFNA) showed the strongest association, with higher maternal PFNA linked to increased autism-related traits (adjusted β = 1.5).
- The overall PFAS mixture and sex differences were not consistently associated with autism-related traits.
Conclusions:
- Prenatal exposure to perfluorononanoic acid (PFNA) may be associated with modest increases in child autism-related traits.
- Further research is needed to explore PFAS (legacy and emerging) relationships with quantitative autism-related outcomes.
- Continued investigation into environmental exposures and neurodevelopmental outcomes is crucial.
Background:
Epidemiologic evidence linking prenatal exposure to per- and polyfluoroalkyl substances (PFAS) with altered neurodevelopment is inconclusive, and few large studies have focused on autism-related outcomes. We investigated whether blood concentrations of PFAS in pregnancy are associated with child autism-related outcomes.
Methods:
We included 10 cohorts from the National Institutes of Health (NIH)-funded Environmental influences on Child Health Outcomes (ECHO) program (n = 1,429). We measured 14 PFAS analytes in maternal blood collected during pregnancy; eight analytes met detection criteria for analysis. We assessed quantitative autism-related traits in children via parent report on the Social Responsiveness Scale (SRS). In multivariable linear models, we examined relationships of each PFAS (natural log-transformed) with SRS scores. We further modeled PFAS as a complex mixture using Bayesian methods and examined modification of these relationships by child sex.
Results:
Most PFAS in maternal blood were not associated with child SRS T-scores. Perfluorononanoic acid (PFNA) showed the strongest and most consistent association: each 1-unit increase in ln-transformed PFNA was associated with greater autism-related traits (adjusted β [95% confidence interval (CI)] = 1.5 [-0.1, 3.0]). The summed mixture, which included six PFAS detected in >70% of participants, was not associated with SRS T-scores (adjusted β [95% highest posterior density interval] = 0.7 [-1.4, 3.0]). We did not observe consistent evidence of sex differences.
Conclusions:
Prenatal blood concentrations of PFNA may be associated with modest increases in child autism-related traits. Future work should continue to examine the relationship between exposures to both legacy and emerging PFAS and additional dimensional, quantitative measures of childhood autism-related outcomes.
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